Int J Biometeorol (2014) 58:1825–1843

DOI 10.1007/s00484-013-0785-1

ORIGINAL PAPER

Elderly bioheat modeling: changes in physiology,

thermoregulation, and blood flow circulation
Mohamad Rida & Nesreen Ghaddar & Kamel Ghali &
Jamal Hoballah

Received: 9 October 2013 / Revised: 22 December 2013 / Accepted: 28 December 2013 / Published online: 24 January 2014
# ISB 2014

Abstract A bioheat model for the elderly was developed Nomenclature

focusing on blood flow circulatory changes that influence A Area (m2)
their thermal response in warm and cold environments to ADu Dubois surface area (m2)
predict skin and core temperatures for different segments of AVA Arteriovenous anastomoses
the body especially the fingers. The young adult model of BMR Basal metabolic rate (W)
Karaki et al. (Int J Therm Sci 67:41–51, 2013) was modified BW Body weight (kg)
by incorporation of the physiological thermoregulatory and c Specific heat (J/kg K)
vasomotor changes based on literature observations of phys- C Thermal capacitance (J/K)
iological changes in the elderly compared to young adults CO Cardiac output (cm3/h)
such as lower metabolism and vasoconstriction diminished CIVD Cold-induced vasodilation
ability, skin blood flow and its minimum and maximum HT Body height (m)
values, the sweating values, skin fat thickness, as well as the h Heat transfer coefficient (W/m2 K)
change in threshold parameter related to core or skin temper- Mcr Core basal metabolic rate (W)
atures which triggers thermoregulatory action for sweating, Msk Skin basal metabolic rate (W)
maximum dilatation, and maximum constriction. The devel- met Standard metabolic rate unit of a seated person equal
oped model was validated with published experimental data to 58 W/m2 of body surface area
for elderly exposure to transient and steady hot and cold m Blood flow rate (kg/s)
environments. Predicted finger skin temperature, mean skin P Vapor pressure (kPa)
temperature, and core temperature were in agreement with PMV Predicted Mean Vote
published experimental data at a maximum error less than Qres Heat dissipated through respiration (W)
0.5 °C in the mean skin temperature. The elderly bioheat Qcr-sk Heat exchange between the core and skin through
model showed an increase in finger skin temperature and a contact resistance (W)
decrease in core temperature in cold exposure while it showed Ra Artery radius (m)
a decrease in finger skin temperature and an increase in core Δt Time step (s)
temperature in hot exposure. t Time (s)
Tcr Temperature (°C)

Keywords Elderly thermal response . Elderly bioheat model . Subscripts

Physiology change with age . Elderly blood circulator system a Artery
adjacent Adjacent node in the previous body segment
M. Rida : N. Ghaddar (*) : K. Ghali
amb Ambient
Mechanical Engineering Department, American University AVA Arteriovenous anastomoses
of Beirut, P.O. Box 11-0236, Beirut 1107-2020, Lebanon bl Blood
e-mail: farah@aub.edu.lb CIVD Cold-induced vasodilation
cr Core
J. Hoballah
Department of Surgery, American University of Beirut Medical co Constriction
Center, P.O. Box 11-0236, Beirut 1107-2020, Lebanon dil Dilation
1826
exp Experimental value
min Minimum
model Model
o Initial
perf Perfusion
res Respiration
sk Skin
sk,exp Exposed skin
shiv Shivering
sur Surface
vein Vein
vein,s The superficial vein
Greek symbol
α Coefficient which is 1 for the chest and 0 for all other
body parts
Introduction
The ability of the human body to regulate its own
temperature declines with aging. The elderly are the
group most vulnerable to experience hyperthermia and
hypothermia (Keatinge and Donaldson 2004;
Vandentorren et al. 2006). In our aging world, the
thermal response and comfort of older adults within
their indoor environments are important factors in their
well-being.
It is well documented in the literature that the neutral
thermal sensation of elderly people at operative temper-
ature between 24 and 28 °C during summer and be-
tween 22 and 25 °C during winter is very similar to
that of the young (Hwang and Chen 2010). Their re-
ported neutral thermal sensation at these operative tem-
perature ranges is very similar to that of young people
(Van Hoof 2008), and the same comfort indices apply.
During those thermally neutral conditions, skin temper-
ature ranges between 32 and 34 °C (Guergova and
Dufour 2011). Researchers commonly used the Predict-
ed Mean Vote (PMV) set by ASHRAE (1997) as a
comfort index. The PMV model in general is applicable
to the elderly in neutral and close-to-neutral environ-
ments (Van Hoof and Hensen 2006; DeGroot and
Kenney 2007; Van Hoof 2008; Schellen 2009;
Schellen et al. 2010). It was also reported that the core
temperature in healthy older adults was not different
from that in younger persons under resting
thermoneutral condition (DeGroot and Kenney 2007).
However, in a more stressful thermal environment,
the similarity in comfort sensation between the elderly
and the young may not be the case. The more is the
deviation in environmental conditions from the
thermoneutral range of summer and winter neutral
Int J Biometeorol (2014) 58:1825–1843
operative temperatures, the wider is the difference in
sensation between the two population groups. Schellen
et al. (2010) showed that elderly thermal sensation was
related to air temperature only while that of younger
subjects was related to skin and air temperatures. Taylor
et al. (1995) reported that elderly people may need an
additional strong thermal stimulus to obtain suitable
behavioral responses in a home environment, and they
allowed larger oscillation in room temperature. Tsuzuki
and Iwata (2002) and Tsuzuki and Ohfuku (2002) re-
ported based on experiments that the metabolic rate of
the elderly was 70 % that of the young and that the
elderly subjects’ mean skin temperature was higher in a
colder environment and lower in a warmer environment
than that of the younger subjects. They also found that
elderly subjects have a reduced warmth sensitivity in
cold seasons and cold sensitivity in hot seasons
(Tsuzuki and Iwata 2002). The differences in thermal
sensation and thermoregulation between the elderly and
the young population are caused by changes in physi-
ology (Inoue et al. 1992; Hashiguchi et al. 2004; Van
Hoof and Hensen 2006; Van Someren 2007; Van Hoof
et al. 2008; Schellen et al. 2010). There are many bioheat
models that are capable of predicting the thermal response
of young adults with associated thermal sensation and
thermal comfort based on skin and core temperatures
like the Fiala model (Fiala et al. 2012), KSU model
(Smith 1991), Berkeley Model (Huizenga et al. 2001), and
AUB model (Salloum et al. 2007). If we aim to predict the
healthy elderly thermal response in a thermally stressful
environment by modeling, we must understand changes
in their physiology and thermoregulation and use a
model that can take into consideration the observed
physiological changes connected with circulation and
metabolism.
Numerous empirical studies in the literature have
reported changes between young adults and elderly in
thermal physiology, thermoregulation, and basal metab-
olism (Hashiguchi et al. 2004; Van Hoof and Hensen
2006; Van Someren 2007; Van Hoof et al. 2008; Schellen
et al. 2010). Both metabolic and vasomotor responses are
reduced for the elderly while their core body temperature
is reported to drop at mild ambient cooling more than
it did in younger subjects (Kenney and Munce 2003).
The changes in the organs and body function in the
elderly result in the inability of the body to maintain
the core temperature needed for thermal comfort (Van
Someren 2007). In young adults exposed to a cold envi-
ronment, the body core temperature drops more than
2 °C below the normal value of 37 °C when the body is
exposed for a long time to a very low ambient temperature
(Inoue et al. 1992). During cold stress, the physiological
response of the body is to decrease heat loss by peripheral
Int J Biometeorol (2014) 58:1825–1843
vasoconstriction and to increase heat production through
shivering. Empirical research has shown that vasocon-
striction responses in the elderly are not only delayed,
but they have also diminished in the skin (DeGroot et al.
2006). Enomoto et al. (1992) showed a declined ability to
regulate body temperature through cutaneous vasoconstric-
tion function at the extremities. The diminished ability of
aged skin to vasoconstriction is reported for both acral
(skin with high vascular circulation such as ears, fin-
gers, and facial skin) and non-acral skin (Kenney and
Munce 2003).
Van Someren (2007) reported that with aging, the
finger skin becomes thinner because the underlying fat
is reduced with time, the dermal capillary architecture
changes, and the number of capillary loops (arteriove-
nous anastomoses (AVAs)) decreases. AVAs play a ma-
jor role in thermoregulation through the extremities and
are influenced by core and local skin temperatures
(Daanen 1991, 2003; Karaki et al. 2013). Van Someren
(2007) reported that AVAs in the fingertip location keep
much higher blood flow in elderly fingers during cold
conditions compared to young people. In addition, the
cold-induced vasodilation (CIVD) reaction occurrence
for the elderly is delayed and is less pronounced in
the elderly when compared to young people. The CIVD
reaction is affected by the decrease in core temperature
due to a decrease in basal metabolic rate and the re-
duced physical activity in the elderly (Daanen 2003).
Anderson et al. (1996) observed that the tympanic
temperature of the elderly at rest is 36.7 °C which is
0.4 °C less than that of the young adult at a value of
37.1 °C. They also reported that the null zone range
(difference between core thresholds for cessation of
sweating and onset of shivering) was significantly great-
er in the elderly at 1.1 °C (SD 0.4 °C) compared to the
young at 0.4 °C (SD 0.1 °C). Sessler (2008) also
observed that shivering is less in the elderly due to
the lower shivering threshold core temperature and to
the smaller muscle mass. When the elderly are exposed
for a long period to cold without shivering, the core
temperature will decrease and it will take more time to
reach the threshold temperature. Basically, the vessels
of the elderly fail to constrict effectively in the extrem-
ities during cold exposure which in turn results in a
higher skin temperature than young people, thus in-
creasing the heat loss and further declining the core
temperature. Enomoto et al. (1992) reported that the
elderly skin temperature drop, when subject to wind,
was larger than that of the young group, which was
indicative of the poor circulatory function in the ex-
tremities. They also observed that elderly subjects need
more time to get a steady state in skin temperature
(Enomoto et al. 1992).
1827
When considering the thermal response of the elderly
in a hot environment, it is observed that the low blood
circulation of the elderly (lower activity and reduced
basal metabolic rate) resulted in a lower skin tempera-
ture in the extremities and a higher core temperature
compared to young adults, showing failure of the circu-
latory system function of cooling the body core. With
advancing age, the peripheral blood vessels change
structurally and functionally. The elderly show a signif-
icant reduction in blood flow which affects heat transfer
from the body (Kenney and Havenith 1993; Rooke
et al. 1994; Kenney and Munce 2003; Holowatz and
Kenney 2010). This means that less vasodilation occur
in the skin for the elderly. Tochihara et al. (1993)
showed that the rate of increase in skin temperature
for the elderly group was significantly smaller than that
for the younger group, which means a delay in time to
have vasodilation in the skin for the elderly compared
to the young (Tochihara et al. 1993; Bjerke 2010).
Sagawa et al. (1988) reported in their experimental
study that differences in sweating responses existed
between the elderly and young people during heat ex-
posure. They reported that the elderly sweating thresh-
old is triggered at a slightly higher skin temperature
than that for the younger group. They also reported that
the elderly sweat volume is 18.6 g/m2 less than that of
the young with a reduction of 12 min in sweat duration
(Sagawa et al. 1988). Hirata et al. (2012) reported that
the threshold for sweating of the elderly is about 1.5 °C
higher compared to the young skin threshold tempera-
ture for sweating based on the model of Nagaoka et al.
(2004) and experimental data of Dufour and Candas
(2007). Wang et al. (2007) reported that thermoregula-
tory and vasomotor changes at the hands and fingers
play a major role in specifying thermal sensation in
elderly subjects. We can clearly conclude that the elder-
ly thermal sensation and comfort are affected by the
change of their thermoregulatory and vasomotor re-
sponses. It is also evident that cold and heat stress are
not well tolerated by the elderly and generally can lead
to health hazards.
Researchers have addressed some of the physiological
changes in elderly bioheat modeling by modifying the
basal metabolic rate (BMR), cardiac output (CO), body
weight (BW), Dubois surface area (ADu), and height
(HT) (Novieto and Zhang 2010a, b). Novieto and Zhang
(2010a) reported an elderly bioheat model by modifying
the known IESD-Fiala model (Fiala 1998; Fiala et al.
2001) but did not include the circulatory system for the
digits. An elderly bioheat model is considered robust if
it can accurately predict the blood flow in the extrem-
ities including the fingers and their effect on the core
temperature under stressful cold or warm environment
1828 Int J Biometeorol (2014) 58:1825–1843

for a given metabolic rate and clothing resistance. The
blood flow system has the most influence on elderly
thermal response when subjected to cold and warm
environments outside the thermoneutral comfort zone.
Karaki et al. (2013) have developed a segmental bioheat
model that includes independent hand and finger seg-
ments. They based their model of body thermal re-
sponse on detailed modeling of blood circulation in
the arteries and veins, AVA function in the extremities,
and blood perfusion to the skin. The model of Karaki
et al. (2013) was later extended by Rida et al. (2014)
for accurate prediction of CIVD response. Bioheat
models are mainly developed based on the physiology
of the young, and they need to be modified for the
elderly. The model of Karaki et al. (2013) has features
for modeling blood flow in general based on cardiac
output and in the extremities in particular which lends
itself to be easily modified to incorporate elderly blood
flow physiology and associated thermal response.
The aim of this work is to develop a bioheat model for
healthy old adults while focusing on blood flow circulatory
changes that influence their thermal response in warm and
cold environments. The healthy elderly model is derived from
the bioheat model of Karaki et al. (2013) for the young adult
while taking into consideration the observed physiological
changes associated with age such as lower metabolism and
vasoconstriction diminished ability of the elderly human
body. The model predictions of segmental skin and core
temperatures will be validated with published experimental
data in the literature of measured values in transient and
steady thermal environments. The segmented bioheat mod-
el can be integrated with clothing and space models and
hence can become a useful tool in many applications. For
example, the model can be used for assessment of the
suitability of an air-conditioning or heating system for the
elderly. It can also be used for assessing risk and
recommending safe exposure periods of the elderly to a
cold environment where hypothermia occurs when the
core temperature falls below 33 °C causing a discontinuity
in shivering with loss in sensation of cold after the period
of pain in the exposed parts (Canada Center for
Occupational Health and Safety 2012).
of Rida et al. (2014) will be modified with respect to
these three features to model accurately the elderly
change in physiology related to vasoconstriction at the
extremities and the reduced metabolic rate and cardiac
output. The elderly bioheat model will predict local and
overall thermal and blood flow responses to changes in
environmental conditions and clothing as well as their
values at hot and cold steady environmental conditions.
The developed elderly bioheat model will be validated
by published experimental data on elderly core and
segmental skin temperatures.
The bioheat model divides the human body into 25
segments, as shown in Fig. 1, which include the head,
upper trunk, lower trunk, upper arms, lower arms, palms
and fingers, thighs, calves, and feet. The modeling of
blood flow was based on a modified multi-branched
arterial tree model of Avolio (1980) to include the five
fingers for each hand. For a known metabolic rate, the
blood flow into each individual body segment including
the fingers is determined. Each segment is composed of
a core node, skin node, artery node, vein node, and,
when applicable, a superficial vein node as shown in
Fig. 2. This model includes the blood perfusion in the
capillary bed, which plays a critical role in heat transfer
of tissues. In addition, it implements the AVA mecha-
nism in the peripheral body segments: forearms, palms,
fingers, calves, and feet. Karaki et al. (2013) included
the temperature threshold for vasodilation,

Mathematical model

The main feature in the development of our elderly

bioheat model is the ability to consider, in the blood
circulatory system, the following physiological changes:
(1) cardiac output, (2) vasoconstriction and vasodilation
of the arterial system, and (3) the AVA control mecha-
nism. The young adult bioheat model of Karaki et al.
(2013) and the model of thermoregulatory AVA function Fig. 1 The segments of the human body used in the bioheat model
Int J Biometeorol (2014) 58:1825–1843
Fig. 2 Different nodes of the peripheral body segments including artery,
core vein, and superficial skin vein nodes
vasoconstriction, shivering, and sweating. Vasodilation
for a typical adult occurs when the core temperature
increases above the neutral values of 36.8 °C for core
temperature and 33.7 °C for skin temperature. The max-
imum vasodilation happens when the body temperature
is 37.2 °C (Karaki et al. 2013). The maximum vasocon-
striction happens when the skin temperature reaches
27.8 °C (Smith 1991). When the skin temperature falls
below thermoneutrality, the vasoconstriction mechanism
starts in order to decrease heat loss, and when an
additional decrease in body temperature takes place,
shivering starts with the body producing mechanical
work in order to generate heat. Shivering starts when the
core temperature is less than or equal to 35.8 °C. When the
core temperature is equal or greater than 37.1 °C, the shivering
phenomenon will stop, and between 35.8 and 37.1 °C, the
shivering threshold will decrease linearly with the variation of
the core temperature (Smith 1991).
Similar to the young bioheat model, energy balance
calculations are performed for the nodes of the core,
skin, artery, and vein and for the superficial vein as
applicable for each body segment following the formu-
lation of Karaki et al. (2013) while introducing modifi-
cations reflecting elderly changes in the physiology of
the circulatory system. These changes include reduced
metabolic rate proportionally for each segment and the
change in physiology for the AVA blood flow for the
diminished vasoconstriction in the extremities. In non-
periphery segments, the blood comes in through the
artery while the blood returning through the core vein
is the combination of blood from the previous vein
(m prev;vein ) and the blood coming in through perfusion
1829
from the core. In terminal body segments such as the
forearms, hands, and fingers where there are superficial
veins, the blood returning through the superficial vein is
the blood from the previous superficial vein (m prev;s;vein
) plus the blood perfusion through the skin and also
through the AVA. The body segments which contain the
superficial vein node are the ten digits of the hand,
hands, and forearms.
Using lumped capacitance, there are five nodes for
the energy balance in each peripheral segment derived
from the work of Salloum et al. (2007) and Karaki
et al. (2013) and reported in the Appendix. The bioheat
model solves transient energy balance equations of the
nodes of each body segment constrained by the elderly
modified thermoregulatory controls to predict segmental
core and skin temperatures and arterial blood flow for
given metabolic rate and environmental conditions
(Karaki et al. 2013; Rida et al. 2014). In this section,
we will only focus on modeling aspects that have been
modified in their young adult bioheat model.
The basal parameters of the young adult model need
to be modified to produce the elderly bioheat model.
The parameters modified by Novieto and Zhang (2010a,
b) include the basal metabolic rate (BMR), cardiac
output (CO), body weight (BW), Dubois surface area
(ADu), and height (HT). They adopted a decrease of
20 % in BMR, 14 % in CO, 10 % in BW, and 7 %
in BSA for the overall body. Novieto and Zhang
(2010b) adopted a 30 % decrease in basal core meta-
bolic rate and 20 % decrease in basal skin metabolic
rate which we have adopted in our current model. These
changes are based on established experimental findings
on the physiology of healthy elderly above 60 and
70 years old (Collins et al. 1977; Sessler 2008; Bjerke
2010). Since the current model is multi-segment and
multi-node, careful consideration of blood flow model-
ing is needed to be able to include the rise in blood
perfusion to the skin during cold condition, the decrease
in blood perfusion to the skin during hot condition, the
decrease of metabolic rate during hot and cold condi-
tions, and the decrease in cardiac output which are also
modified as they affect significantly the elderly thermal
response. Humans show a weakening in cutaneous and
skin blood flow with respect to age, and it does vary
from 25 to 50 % when comparing young people of 18
to 30 years old and healthy adults aged above 60 years
old (Kenney and Havenith 1993; Rooke et al. 1994;
Waller and Maibach 2005; Holowatz and Kenney
2010). Kenney and Havenith (1993) tabulated experi-
mental data on skin blood flow comparison between
young and elderly at different environmental conditions.
The overall percentage change from young to old
adults in physiological data of overall core and skin
1830 Int J Biometeorol (2014) 58:1825–1843

Table 1 Reported percentage change in physiological data from the plied with the same proportion to each segment of the
young to the elderly
elderly body. Table 2 summarizes the physiological
Physiological Percentage change Reference values used in our model of segmental and overall core
parameter of data value from and skin metabolic rate, skin blood flow and its mini-
young to old adult mum and maximum values, the sweating values, and
(%)
skin fat thickness as compared to the young adult
Basal core 70 Tsuzuki and Iwata (2002) bioheat model values published in Salloum et al.
metabolic Novieto and Zhang (2010b) (2007) and Karaki et al. (2013). The thermoregulatory
rate (W) action for sweating, maximum dilatation, and maximum
Basal skin 80 Tsuzuki and Iwata (2002)
metabolic
constriction is triggered by a threshold parameter related
Novieto and Zhang (2010b)
rate (W) to core or skin temperatures. The changes in threshold
Basal skin blood 100 Collins et al. (1977) parameter for sweating (Sagawa et al. 1988) and max-
flow (cm3/s) imum dilatation (Hirata et al. 2012) in the elderly have
Min skin blood 150 Collins et al. (1977)
flow (cm3/s)
been reported in the literature and are summarized in
Waller and Maibach (2005)
Table 3. In addition, the maximum vasoconstriction
Max skin blood 70 Holowatz and Kenney
flow (cm3/s) (2010)
threshold for segmental skin temperature used by Smith
(1991) for young adults was reduced by 0.5 °C, and the
Kenney and Havenith
(1993) maximum constriction to represent the delay in the
Rooke et al. (1994) vasoconstriction response was also best representing
Sweat factor 80 Sagawa et al. (1988) experimental observations (Tochihara et al. 1993;
Hirata et al. (2012) Bjerke 2010). Threshold values are used in calculation of
Cold shivering 90 Sessler (2008) skin perfusion (m perf ;sk ) which varies between a minimum
factor and a maximum based on local core and skin temperatures as
Fat skin thickness 80 Bjerke (2010) given by Smith (1991) and Karaki et al. (2013).
(mm)

:
m perf ;sk;dil ⋅m perf ;sk;con
m perf ;sk ¼ ð1Þ
metabolic rate, skin blood flow and its minimum and m perf ;sk;basal
maximum values, the sweating values, and skin fat
thickness is provided in Table 1. These reductions in
values of physiological data related to metabolism and where the values of m perf ;sk;dil and m perf ;sk;con are modified
blood flow for the whole body change have been ap- accordingly with the new threshold of the elderly to become

8 :
> mperf ;sk;basal for T cr ≤ 36:85  C
<
: T cr −36:85
: :  :
mperf ;sk;dil ¼ m perf ;sk;max − m perf ;sk;basal þ m perf ;sk;basal for 36:85 C ≤ T cr ≤ 37:25 C
>
: 37:25−36:85 :
8: m perf ;sk;max for T cr ≥ 37:25  C
> m for Tsk ≤ 10:2  C
< perf ;sk;min
 :
: T sk −10:2 : :
mperf ;sk;con ¼ m perf ;sk;basal −m perf ;sk;min þ mperf ;sk;min for 10:2 C ≤ T sk ≤ 33:2 C
>
: 33:2−10:2
:
m perf ;sk;basal for T sk ≥ 33:2  C

The derivation of the control system equations for
calculating the skin blood vessel radii during vasodila-
tion or vasoconstriction is based on the model of Smith
(1991) which assumes a body state of thermoneutrality
when the core and mean skin temperatures are 36.8 and
33.7 °C, respectively. As the core temperature rises
above its neutral value, cardiac output increases and
vasodilation increases to reach the maximum state of
vasodilation when the core temperature reaches
37.2 °C. As the mean skin temperature falls below its
neutral value of 33.7 °C, vasoconstriction occurs. Skin
blood flow and cardiac output decrease accordingly and
a state of maximum vasoconstriction occurs when the
mean skin temperature falls to 10.7 °C. Between these
two extreme cases, Smith (1991) assumed a linear rela-
tion for the radius variation of the blood vessels. The
 Int J Biometeorol (2014) 58:1825–1843

Table 2 Physiological values used in our model of segmental and overall core and skin metabolic rate, skin blood flow, and its minimum and maximum values, the sweating values, and skin fat thickness as
compared to the young adult bioheat model values published in Salloum et al. (2007) and Karaki et al. (2013) based on Smith (1991) data

Adult body segment Basal core metabolic Basal skin metabolic Basal skin blood flow Min skin blood flow Max skin blood flow Sweat factor Cold shivering Fat skin thickness
rate (W) rate (W) (cm3/s) (cm3/s) (cm3/s) factor (mm)

Young Old Young Old Young Old Young Old Young Old Young Old Young Old Young Old

Finger 0.0048 0.0034 0.0042 0.0034 27.9 27.9 10 15 80.4 56.3 0.0016 0.0012 0.00002 0.000018 3.30 2.64
Palm 0.0710 0.0497 0.0351 0.0281 417.9 417.9 215.06 322.5 1,726.7 1,208.7 0.0078 0.0062 0.0001 0.00009 7.40 5.92
Forearm 0.5930 0.4151 0.1378 0.1102 508.0 508.0 0 5 5,553.0 3,887.1 0.0326 0.0261 0.0014 0.00126 4.51 3.61
Upper arm 1.06 0.7434 0.1820 0.1456 910.0 910.0 0 5 8,319.0 5,823.3 0.0444 0.0355 0.0024 0.00216 4.51 3.61
Foot 0.1459 0.1021 0.1270 0.1016 934.0 934.0 266 399 5,278.0 3,694.6 0.0175 0.0140 0.0004 0.00036 11.70 9.36
Calf 0.7540 0.5278 0.1530 0.1224 651.0 651.0 0 5 8,253.0 5,777.1 0.0445 0.0356 0.0017 0.00153 10.64 8.51
Thigh 1.708 1.20 0.3428 0.2743 1,456.0 1,456.0 0 5 12,453.0 8,717.1 0.0645 0.0516 0.0039 0.00351 10.64 8.51
Head 18.43 12.90 0.2190 0.1752 6,050.0 6,050.0 1,206 1,809 16.552.0 11,586.4 0.0810 0.0648 0.0775 0.06975 8.50 6.80
Lower chest 46.86 32.80 0.6075 0.4860 2,272.5 2,272.5 0 5 21,953.0 15,367.1 0.2060 0.1648 0.3875 0.34875 19.12 15.30
Upper chest 5.96 4.17 0.6075 0.4860 3,441.5 3,441.5 0 5 33,246.0 23,272.2 0.2750 0.2200 0.515 0.4635 19.12 15.30
Overall bodya 79.96 55.97 3.43 2.75 21,796.5 21,796.5 2,268.1 3,452.2 155,720.9 109,004.6 1.0 0.8 1.0 0.9 178.54 142.83

a
Overall values are the sum of ten fingers, two palms, two forearms, two upper arms, two feet, two calves, two thighs, the head, the lower chest, and the upper chest
1831
1832 Int J Biometeorol (2014) 58:1825–1843

Table 3 Threshold parameter

change for thermoregulatory ac- Thermoregulatory action Threshold control Young adult Old adult
tion in the elderly compared to parameter (°C) (°C)
young people
Sweating (Sagawa et al. 1988) Tcore 36.9 36.95
Start of vasodilation Tcore 36.8 36.85
Maximum dilatation (Hirata et al. 2012) Tcore 37.2 37.25
Start of vasoconstriction (Karaki et al. 2013) Tskin 33.7 33.2
Maximum constriction parameter of the Tskin 10.7 10.2
thermoregulatory equations of Smith (1991)
(Tochihara et al. 1993; Bjerke 2010)

vasomotor equations developed by Smith (1991) were
used by different researchers (FU 1995; Iyoho et al.
2009; Salloum et al. 2007) and resulted in robust pre-
dictions of skin and core temperatures at different
steady and transient environmental conditions. In our
new model for the elderly, the lower threshold for
maximum vasoconstriction was taken as 10.2 °C as it
resulted in better match to published experimental re-
sults as shown later in the “Results and discussion”
section. Note that for the elderly, the threshold skin
temperature for constriction is lowered by 0.5 °C which
results in delayed sensation for cold while the dilatation
threshold, which is controlled by the core temperature,
is slightly higher by 0.05 °C over the value for young
people. The AVA control mechanism in the ten digits in
this model depends on the local skin temperature of the
finger which is affected by the modified elderly skin
perfusion. The adopted AVA model is that of Rida et al.
(2014) and will not be repeated here.
The cardiac output equations are controlled by the
skin and core temperatures (Fu 1995). As for the elderly
cardiac output, we have reduced the values reported by
Fu (1995) on young adult basal cardiac output, con-
stricted COcon, and dilated COdil cardiac outputs by
3.4 % to obtain elderly CO values in cubic centimeter
per hour as reported by Novieto and Zhang (2010b).
This resulted in a maximum vasoconstriction cardiac
output of 260,820 cm3/h at Tsk ≤10.2 °C, basal cardiac
output at thermal neutrality of 280,000 cm3/h (Tsk =
33.2 °C), and maximum vasodilation cardiac output of
412,900 cm3/h at Tcr ≥41 °C. The total cardiac output is
generally determined using the equation of Fu (1995)
and Iyoho et al. (2009) as follows:
COdil ⋅ COcon
CO ¼ ð2Þ
280; 000
while COcon and COdil are calculated respectively after
adjusting the elderly thresholds as follows:

COcon ¼ 280; 000 T sk ≥ 33:2  C

ðT sk − 10:2Þ  ð280; 000 −260; 820Þ
COcon ¼ T sk > 10:2 C and T sk < 33:2 C ð3aÞ
ð33:2− 10:2Þ þ 260; 820:0

COcon ¼ 260 ; 820 T sk ≤ 10:2 C

COdil ¼ 412 ; 900 T cr ≥ 41  C

ðT cr −37:25Þ  ð508; 000−400; 000Þ
COdil ¼ T cr ≥ 37:25 and T cr < 41  C
ð41−37:25Þ þ 400; 000
ð3bÞ
ðT cr −36:85Þ  ð412; 900−280; 000Þ
COdil ¼ T cr > 36:85 C and T cr < 37:25 C
ð37:25−36:85Þ þ 280; 000
COdil ¼ 280;000 T cr ≤ 36:85  C

Note that the skin blood vessel radii change during The corrected values of CO for the elderly have been
vasomotor response as a function of cardiac output as used in the calculation of the arterial radius Ra during
reported by Karaki et al. (2013), dilating with higher vasomotor response (Smith 1991; Karaki et al. 2013)
core temperatures and constricting with lower ones. which apply to the radii of the arteries in the neck,
Int J Biometeorol (2014) 58:1825–1843
upper arms, forearms, palms, thighs, calves, and feet
based on the cardiac output. The arterial radius Ra for
any segment is given by
vffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
 
u
u − a;min  ðCO − 260; 820Þ
R 2
R 2
t a;max
Ra ¼ R2a;min þ
ð412; 900 − 260; 820Þ
where Ra,min is the maximum constricted radius of the artery
and Ra,max is the maximum dilated radius of the artery with
data obtained from Smith (1991). However, the radii of the
arteries in the fingers were modeled as a function of the local
finger skin temperature to have a better control during finger
cold exposure and are given by
vffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
 
u
u R2a;max − R2a;min  ðT sk −12Þ
t 2
Ra;finger ¼ Ra;min þ
ð35−12Þ
Any change in arterial radii directly influences terminal
impedances and arterial blood flow into the body segments
and extremities affecting their thermal response. The imped-
ance and blood flow calculations have to be repeated at each
time step in the model.
Numerical method
Figure 3 shows a flow chart of the different modeling steps in
the simulated bioheat model. The numerical methodology is
based on the Euler forward first-order scheme of Salloum et al.
(2007) with a time step Δt. For a given initial thermal state of
the human body, metabolic rate, ambient conditions, and the
physiological and physical parameters inherent in the bioheat
model of the elderly human body, the simulation program will
update at every time step, i, the core and regional blood flow
rates, the AVA blood flow thermoregulatory responses, skin
vapor pressure, and temperatures of the core, skin, artery, vein,
and superficial vein nodes. At the start of any simulation, the
AVA is initialized to zero and the associated bioheat model is
allowed to reach a steady state at the initial conditions of any
simulated experiment (metabolic rate and environment condi-
tions of the room) before beginning any transient analysis
associated with any other form of transient imposed either
by changes in room conditions or activity level of the human.
In other words, suitable initial conditions were determined
starting from the neutral conditions of Tcr =36.7 °C and Tsk =
33.7 °C to simulate a relatively long exposure to any precon-
ditioning environment. The obtained steady state values were
then used as initial conditions for other unsteady calculations
of various node temperatures for all segments. A time step Δt
of 0.02 s is used over the desired simulation period given that a
complete cycle of the heartbeat approximately takes 0.8 s at
1833
the neutral state of the body and can vary depending on the
metabolic rate and core temperature.
Results and discussion
ð4aÞ
In this section, the elderly bioheat model based on the thermal
modeling physiology of old adults is validated by comparing
published experimental data of local and mean skin tempera-
tures and body core temperatures for transient experiments
conducted on old adult subjects with predicted values by
simulation of the same steady or transient experimental con-
ditions, clothing type, and activity level. The validation will
confirm the model ability in predicting elderly thermal re-
sponse with all embedded model assumptions of elderly phys-
iology related to the blood circulatory system and reduced
ð4bÞ metabolic rate.
Model validation with published experimental data
The elderly bioheat model validation is performed with respect
to mean skin and core temperatures as well as finger skin
temperature against published experimental data under normal
environmental conditions and under extreme hot and cold con-
ditions for both transient and steady state conditions. This is
followed by validation on reported experiments of skin temper-
ature of different elderly body segments in a cold environment.
Tsuzuki and Iwata (2002) published experimental data on
the variation of the mean skin temperature of eight elderly
participants at sedentary and at light exercise conditions in
climatic chambers at temperatures of 23 and 27 °C and 60 %
relative humidity. The duration of each experiment was
180 min to ensure that steady state conditions have been
reached. Additional similar experiments were also reported
by Tsuzuki and Ohfuku (2002) in which 109 elderly and 100
young people were for comparative assessment of thermoreg-
ulation between elderly and young people exposed to five
environmental conditions ranging from 23 to 31 °C all at
60 % RH under insensible air flow. The conditions of these
steady state experiments have been performed using our cur-
rent model for both young and elderly. The initial state of each
simulation started from a conditioning period at 28 °C with a
clothing resistance at 0.6 clo. The metabolic rate was about
1.3 met (for talking and reading activities, 1 met=58 W/m2).
Note that for young persons, the reported metabolic rate in the
experiments was about 60 W/m2 for the young and around
39 W/m 2 for the elderly (Tsuzuki and Ohfuku 2002).
Figure 4a–c shows the experimentally published mean skin
temperature of young and old adults (Tsuzuki and Ohfuku
2002) and the model predicted mean skin temperature of
elderly and young adults at environment temperatures of (a)
23, (b) 27, and (c) 31 °C. The bioheat model predicts both
elderly and young mean skin temperatures with an error less
1834
Fig. 3 A flow chart of the
different modeling steps in the
simulated bioheat model
than 0.5 °C. The differences between elderly and young
mean skin temperatures are clear at environment tem-
peratures of 23 °C and when the environment tempera-
ture is high at 31 °C. At the lower environment tem-
perature, the elderly mean skin temperature is 0.8 °C
higher than that of young adults, while at an environ-
ment temperature of 31 °C, the elderly mean skin tem-
perature was 0.3 °C lower than that of young persons.
Alternatively, oral temperature at 31 °C environment
Int J Biometeorol (2014) 58:1825–1843
was higher in the elderly group and it was lower at
the end of the experiment of the 21 °C environment. At
27 °C, the mean skin temperature was lower in the
elderly than in the young, but it did vary during the
transient since it was closest to the initial neutral state
condition. In general, the elderly have lower mean skin
temperature at high temperature and higher temperature
at low ambient condition, and this has been captured by
the current elderly bioheat model.
Int J Biometeorol (2014) 58:1825–1843
Fig. 4 Plots of the
experimentally published mean
skin temperature of the young and
old adults (Tsuzuki and Ohfuku
2002) and the model predicted
mean skin temperature of the
elderly and young adults at
environment temperatures of a 23,
b 27, and c 31 °C
The steady state condition within thermoneutral tempera-
ture range is not a critical range for showing the differences in
thermal response of the elderly as compared to the young. For
a robust model, validation must be done in the critical ther-
mally stressful conditions where the elderly may be exposed
to an extreme weather outside the residence area or when in an
unconditioned space during cold and hot seasons. Also, the
elderly show more thermoregulatory changes than the young
in their vasomotor responses under exposure to temperatures
outside the thermoneutral range. For this reason, we will
validate the elderly bioheat model with published experimen-
tal data for cold and hot seasons where extremities play a
critical role in thermoregulations.
Tochihara et al. (1993) reported experimental data on
finger skin temperature and oral temperature of ten
elderly and ten young participants subject to cold and
1835
hot environments. The subjects changed into the stan-
dard clothing (0.63 clo) and stayed in the neutral envi-
ronment (25 °C) for 23 min; thereafter, they were ex-
posed to the cold (10 °C) or hot (35 °C) environment
for 49 min. They reported a slight change in oral
temperature while observing that the difference between
elderly and young group change in oral temperature was
insignificant. We simulated the experiments of Tochihara
et al. (1993) for the following two conditions:
1. Cold environment exposure in which the subject is exposed
to 25 °C for 23 min followed by 49 min of exposure to the
environment at 10 °C and 40 % relative humidity
2. Hot environment exposure in which the subject is exposed
to 25 °C for 23 min followed by 49 min of exposure to the
environment at 35 °C and 40 % relative humidity
1836
Figure 5a, b shows the variation in time of the predicted
finger skin temperature for the elderly and young adults
during (a) cold exposure conditions and (b) hot exposure
conditions for the experiments of Tochihara et al. (1993) in
addition to the corresponding published experimental values.
The elderly bioheat model predicts accurately the transient
finger skin response during cold exposure and shows also that
the elderly finger skin temperature could stabilize at a value
that is 3 °C higher than that of a young adult. Experimental
results did not show major variation in local finger skin
temperature during exposure to a hot environment at 35 °C
in the experiment of Tochihara et al. (1993), although the
elderly finger skin temperature was slightly colder than that
of young people.
Figure 6 presents the predicted values for both elderly and
young of the finger AVA blood flow rate and blood perfusion
for (a) cold exposure and (b) hot exposure as well as the core
temperature of the chest for (c) cold exposure and (d) hot
exposure, all for the conditions of experiments reported by
Tochihara et al. (1993) and shown in Fig. 5. As was seen from
Fig. 5 Plots of the variation in
time of the predicted finger skin
temperature for the elderly and
young adults during a cold
exposure conditions and b hot
exposure conditions for the
experiments of Tochihara et al.
(1993) in addition to the
corresponding published
experimental values
Int J Biometeorol (2014) 58:1825–1843
Fig. 5a during cold exposure, the finger skin temperature is
higher for the elderly. This is expected due to the delay in
vasoconstriction and to higher finger minimum blood flow in
the elderly compared to the young, as seen in Fig. 6a, which
causes an increase in skin temperature even though the met-
abolic rate is lower while noting that in the elderly, shivering is
characterized by delayed threshold and generating less heat
when compared to the young. Similarly, during hot exposure,
the finger skin blood flow rate is smaller than that of young
people due to poorer circulation capacity associated with
lower cardiac output. This causes the finger skin temperature
to be lower in the elderly compared to young people. In
addition, the simulated core temperature for both the elderly
and young shown in Fig. 6c shows that the elderly have a
lower core temperature than the young during cold exposure
because of the higher heat loss at the extremities due to the
higher amount of blood perfused in the skin layer. Upon
examining Fig. 6d, it is clear that the elderly core chest
temperature in hot condition is slightly higher than that of
the young because of the reserved heat in the body where less
Int J Biometeorol (2014) 58:1825–1843 1837

Fig. 6 Plots of the predicted

values for both the elderly and
young of the skin total and
perfusion blood flow rate in the
finger for a cold exposure and b
hot exposure as well as the core
temperature of the chest for c cold
exposure and d hot exposure, all
for the conditions of experiments
reported by Tochihara et al.
(1993) and shown in Fig. 5

blood goes to the skin compared to the young to cool down
and the malfunction of the sweat gland. In addition, a reduc-
tion in sweating rate gives a higher skin temperature where
there is less evaporation in the skin, and a reduction in max-
imum blood flow causes a lower skin temperature.
Inoue et al. (1992) reported experimental data on elderly
core temperature in which both elderly and young subjects
were exposed to cold environments at 12 and 17 °C for 1 h at a
sedentary state. Figure 7a, b shows the experimentally pub-
lished core temperature by Inoue et al. (1992) and the predict-
ed core temperature by our simulations of elderly and young
models exposed to environments at (a) 12 and (b) 17 °C for
the conditions of the Inoue et al. (1992) experiments. Results
show good agreement where the core temperature dropped to
a lower temperature when the elderly were exposed to the cold
environment. This core temperature drop is caused by the
increase of minimum skin blood flow, the reduced shivering
metabolic rate, and delayed shivering threshold during cold
exposure compared to the young (Inoue et al. 1992; Anderson
et al. 1996). The reduced shivering metabolic rate is not able
to maintain basal core temperature.
During exposure to a slow transient cold air, healthy elderly
subjects showed a lower esophageal temperature than young
subjects as reported in the published experimental work of
DeGroot and Kenney (2007) in which 36 young and 46 old
adults participated. Participants underwent a slow transient
1838
Fig. 7 Plots of the
experimentally published core
temperature by Inoue et al. (1992)
and the predicted core
temperature by our simulations of
elderly and young models
exposed to an environment at a 12
and b 17 °C for the conditions of
the experiments of Inoue et al.
(1992)
cold air exposure from a thermoneutral baseline, during which
esophageal and mean skin temperatures, O2 consumption, and
skin blood flow were measured. We simulated the conditions
of DeGroot and Kenney (2007) where the experiment starts
from a conditioned temperature of 26.5 °C for 20 min and then
the temperature starts dropping at a rate of 0.25 °C/min for
20 min and 0.05 °C/min for the rest of the simulation. The
protocol was terminated when sustained involuntary shivering
was reported by the subject and/or observed by the investiga-
tors. We used the average metabolic rates reported in the
experiment. Figure 8 shows the reported experimental core
temperature of DeGroot and Kenney (2007) and the value of
core temperature predicted by our bioheat model at their
experimental conditions. Good agreement exists and the core
temperature of the elderly was 0.4 °C lower compared to that
of the young. Note that the discrepancy in measured value is
within an experimental error of ±0.2 °C as reported by
DeGroot and Kenney (2007).
Hashiguchi et al. (2004) reported measurements of seg-
mental skin temperature and mean skin and core temperatures
of elderly and young adults sitting in a uniform environment
of 15 °C. The steady state predicted that mean skin and core
Int J Biometeorol (2014) 58:1825–1843
temperatures for the elderly were 31.22 and 36.96 °C, respec-
tively, compared to experimental values of 30.93 and 37.31 °C
as reported by Hashiguchi et al. (2004). The predicted values
of mean skin and core temperatures for young people were
31.68 and 37.16 °C, respectively, compared to experimental
values of 31.3 and 37.4 °C as reported by Hashiguchi et al.
(2004). The predicted palm skin temperature for the elderly
and young was 24.75 and 23.83 °C compared to experimental
values of 24.4 and 24.74 °C, respectively, of Hashiguchi et al.
(2004), while the predicted palm temperature for the elderly
and young was 24.75 and 23.83 °C compared to experimental
values of 24.4 and 24.74 °C, respectively. In addition, the
predicted lower chest/trunk segment temperature for the el-
derly and young was 35.98 and 35.76 °C compared to report-
ed experimental values of 33.05 and 34.94 °C, respectively.
The mean skin temperature and core temperature predictions
have good agreement with experimentally measured values. It
is observed also that small body segments such as the palm,
feet, forearm, and calf have better agreement than large seg-
ments. This deviation is attributed to the large surface area of
the segment lumped in one uniform skin temperature while
the measurements are taken at a single point on the skin. Large
Int J Biometeorol (2014) 58:1825–1843 1839

Fig. 8 Plot of the reported

experimental core temperature
and mean skin temperature of
DeGroot and Kenney (2007) and
the value of core temperature
predicted by our bioheat model at
their experimental conditions

Fig. 9 Plots of the bioheat model

predictions during cold exposure
to 10 °C of a finger skin
temperature and b core
temperature when the metabolic
rate is lowered by 20 % for the
cold environment exposure and of
the c finger skin temperature and d
core temperature when CO was
lowered by 3.5 % of the basal
value from 290,000 to
280,000 cm3/h
1840 Int J Biometeorol (2014) 58:1825–1843

segments such as the chest or thighs have non-uniform skin
temperature distribution that can range between 2 and 3 °C for
healthy people (Jiao et al. 2012).
Sensitivity analysis
In the development of the elderly model, several physiological
parameters that affect elderly thermal response were altered.
These included the decrease of metabolic rate during warm
and cold and the decrease in cardiac output. In this section, we
will analyze the sensitivity of the model thermal response to
changes in these parameters and observe the consistent level
of significance of each of these factors between the young and
old adult models. Although we have validated the model
ability to predict elderly thermal response, it is important to
understand the extent to which these altered parameters im-
pact the predicted response by the elderly bioheat model.
To determine the significance of the changing physiologi-
cal parameters in the bioheat model for young adults devel-
oped by Karaki et al. (2013), the thermal response of the
elderly is simulated in two ambient thermal conditions
representing cold and warm environments, respectively, with
subjects wearing cotton short and socks at a metabolic rate of
1.5 met. Temperature and relative humidity are set at 10 °C
and 40 % for the cold condition and at 30 °C and 40 % in the
warm condition, respectively. The exposure starts after the
human reaches a steady state neutral condition at 28 °C am-
bient temperature and 40 % RH (basically, this is the initial
condition for the simulations).
Sensitivity analysis for cold exposure to 10 °C
Figure 9a–d shows the (a) finger skin and (b) core tempera-
tures when the metabolic rate is lowered by 20 % for the cold

Fig. 10 Plots of the bioheat

model predictions during hot
exposure to 30 °C of a finger skin
temperature and b core
temperature when the metabolic
rate is lowered by 20 % for the
cold environment exposure and of
the c finger skin temperature and d
core temperature when CO was
lowered by 3.5 % of the basal
metabolic rate from 290,000 to
280,000 cm3/h
Int J Biometeorol (2014) 58:1825–1843
exposure and shows the (c) finger skin and (d) core tempera-
tures when cardiac output (CO) was lowered by 3.5 % of a
basal value of 290,000 to 280,000 cm3/h. We can see that
lowering the metabolic rate does not have a large effect on the
finger skin temperature where the difference was less than
0.05 °C; on the other hand, the elderly core temperature does
show a decrease in core temperature of 0.2 °C which is
considered significant for the body core. However, when
cardiac output is decreased by 3.5 %, a very small decrease
is seen in the skin temperature while a small increase of
0.03 °C in core temperature occurred. Although the predicted
changes are insignificant because of the very small local
metabolism in the finger tissues, they reflect the expected
changes in temperature of the body core and finger skin.
Sensitivity analysis for warm exposure to 30 °C
Simulations are carried out for the heating exposure of the
elderly while introducing changes in parameters one at a time
for metabolic rate, skin blood flow, and cardiac output. De-
creasing the metabolic rate by 20 % and its effect on (a) finger
skin and mean skin temperatures and (b) core temperature are
depicted in Fig. 10a, b. It is clear that lowering the metabolic
rate during warm exposure decreased both skin and core
temperatures as expected. The decrease in the finger skin
temperature was 0.02 °C while the decrease in the mean skin
temperature was about 0.14 °C. The core temperature de-
creased about 0.056 °C when the metabolic rate was decreased
by 20 %. Reducing CO by 3.5 % during warm exposure
showed a decrease in the finger skin temperature by about
0.2 °C at the end of the simulation while a very small decrease
occurred in the mean skin temperature (see Fig. 10c). The core
temperature, however, increased by the end of the simulation
by 0.04 °C as shown in Fig. 10d.
Conclusions and further study
The bioheat model for young adults developed by Karaki et al.
(2013) was modified to fit elderly subjects and was validated
with published experimental data showing good agreement
with published experiments on the elderly during cold and hot
exposure experiments.
The physical model captured the differences in thermoreg-
ulatory and vasomotor response in elderly subjects and was
capable of predicting all elderly local and overall thermal
response as well as their local blood flow rates and blood
perfusion in the extremities which play an important role in
response to thermally stressed conditions. The model can be
used for assessing risk and recommending safe exposure
periods of the elderly to a cold environment where hypother-
mia occurs when the core temperature may fall below 33 °C
causing a discontinuity in shivering with loss in sensation of
cold after the period of pain in the exposed parts. It can also be
1841
instrumental for use in designing localized air-conditioning
systems and personalized cooling and heating devices that can
provide comfort for the elderly.
Appendix
Multi-node energy balances of nude segments
Energy balances are performed for the four nodes, core, skin,
artery, and vein of each body segment following the formula-
tion of Karaki et al. (2013). Using lumped capacitance, there
are five nodes for the energy balance in each peripheral
segment (Salloum et al. 2007; Karaki et al. 2013):
The core node
dT cr X

C cr ¼ M cr þ M shiv − W − αQres − Qcr‐sk − hartery Aartery T cr −T bl;a
dt
X

arteries 

− hvein Avein T cr − T bl;v þ m perf;cr þ m perf;sk cbl T bl;a − T cr
veins
ð5Þ
where Ccr is the core thermal capacitance; Mcr and Mshiv are the
basal and segmental thermoregulatory shivering metabolic
rates, respectively; W is the mechanical work done by the
body; α is a coefficient which is 1.0 for the upper chest and
0 for all other body parts; Qres is the heat dissipated through
respiration; hartery and hvein are the convection coefficients of
the blood in the artery and core vein, respectively; Aartery and
Avein are the cross-sectional area of the artery and core vein,
respectively; Tbl,a and Tbl,v are the temperatures of the blood in
the artery and core vein, respectively; m perf ;cr is the blood
perfusion in the core only which is obtained by subtracting the
skin blood perfusion and the AVA blood flow from the total
blood flow into the finger; cbl is the blood specific heat; and
Qcr-sk =K(Tcr −Tsk) is the heat exchange between the core and
skin at conductance K.
The skin node energy balance is given by
dT sk 


C sk ¼ M sk þ Qcr‐sk − Ask;exp hc Tsk;sur − T amb þ hr Tsk;sur − T amb
dt

þhe ðPsk − Pamb ފ þ mperf ;sk þ m AVA cp ðT cr − T sk Þ
X

þ hvein;s Avein;s T bl;v;s − T sk
veins
ð6Þ
where Csk is the skin thermal capacitance, Msk is the skin
metabolic rate, Ask,exp is the exposed skin surface area, hc is
the convection heat transfer coefficient between the skin and
the air, hr is the linearized radiation heat transfer coefficient
(ASHRAE 1997), he is the evaporation coefficient, Tsk,sur is
the skin surface temperature, Pamb is the ambient vapor pres-
sure, Psk is the vapor pressure at Tsk, hvein,s is the convection
1842 Int J Biometeorol (2014) 58:1825–1843

heat transfer coefficient of blood in the superficial vein, Avein,s Daanen HAM (1991) Arterio-venous anastomoses and thermoregulation.
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dT bl;a

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Dufour A, Candas V (2007) Ageing and thermal responses during passive

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